During 1997, the State of New Mexico initiated a program of Medicaid managed care (MMC). It is important to study the effects of this reform in New Mexico, since prior research on managed care has raised substantial questions about its applicability and potential for successful implementation in predominantly rural, poor, and ethnically diverse states. Our project addresses three specific aims, which derive from a conceptual model that traces the effects of health care reform at the individual, organizational/community, and population levels of analysis: 1) To assess individuals'=access, satisfaction, targeted healthcare outcomes, and costs of care before and after implementation of MMC. We will address this aim through survey methods focusing on geographical areas with a high proportion of low-income residents. This component will allow us to study changes in these key indicators at the individual level among Medicaid patients, persons eligible for Medicaid but not enrolled, those covered by other public and private insurance programs, and the uninsured. 2) To examine the effects of MMC reform on safety- net institutions serving at-risk groups and on communities. Ethnographic research methods will address this aim by focusing on income support offices, community health centers, emergency departments, private practitioners' offices, and managed care organizations in both urban and rural areas. 3) To measure changes in preventable, adverse sentinel health outcomes. We will accomplish this aim through the study of administrative databases which provide information about preventable outcomes at the level of the population. The project involves an interdisciplinary team of researchers, spanning several academic units at the University of New Mexico, as well as investigators with the New Mexico Department of Health. This project will provide practical knowledge about the impact of MMC that can guide future policy decisions in New Mexico and other states with rural and ethnically diverse populations. The multimethod approach of combining survey work, ethnographic observations, and study of administrative databases will break new ground in permitting a "triangulation" of complementary methods to reach conclusions about the multifaceted impacts of MMC. This methodologic advance will prove helpful nationally and in other states for the evaluation of future health policy changes.